Monitoring systems and methods

ABSTRACT

Systems and methods for monitoring the performance of a caregiver are disclosed. The systems may be configured to monitor the movement of each caregiver in a network of caregivers. One such system includes a plurality of strips adhered in spaced-apart relation on a mattress pad, upon which a subject is positioned. One or more transmitter is provided coupled to the plurality of strips. A processor in connected to the one or more transmitter. The processor is provided with operating software to record and report caregiver activity or both caregiver activity and subject activity.

FIELD OF THE INVENTION

The present invention relates to systems and methods for monitoringsubjects, such as human subjects. More particularly, the presentinvention relates to systems and methods for monitoring and reportingcaregiver performance in a healthcare setting related to care of asubject on a subject support device, such as on a hospital bed ornursing home bed.

BACKGROUND OF THE INVENTION

Many subjects in nursing homes may not have the physical capability toturn or reposition themselves in a bed and in such a case, depend uponstaff members, typically a Certified Nursing Assistant (CNA) or othercaregiver, to move them. This scenario may also occur in a hospital orsimilar setting. In many instances it is a requirement or medicalnecessity that the subject be turned in bed frequently at a specifiedinterval, such as for example, every two hours, to prevent thedevelopment of tissue or skin breakdown, which can severely compromisehealth, comfort, and quality of life. Failure to periodically move thesubject can result in what is commonly known as pressure sores or“bedsores”.

What is needed is a system and method that can monitor the movement of asubject, patient or resident, (hereinafter referred to simply as“subject”) so that movement of the subject can be detected, tracked,recorded and reported. Accordingly, systems have become available whichalert a caregiver when a subject has moved or left the bed. Some ofthese systems have sophisticated means of determining the position ofthe subject on the bed. As used herein, the terms “CNA” and “caregiver”are used interchangeably and refer to a person providing care to anindividual subject or subjects. Such a system and method may be used tomonitor when a subject leaves and returns to the bed and detect andmonitor patterns of movement. In many cases, subjects are unable tostand or walk from their bed unaided; however, these subjects attempt toexit their bed in a weakened condition and are at risk of falling andassociated injuries. The system has the inherent ability to provide asignal when a subject has exited their bed and will notify theresponsible caregiver of this situation.

These systems do not have a means to allow nursing home administrators,hospital supervisors or healthcare managers (hereinafter referred to as“clients”) to confirm that a CNA or the like has performed his or herduty to move the monitored subject. The present invention addresses thisneed.

SUMMARY OF THE INVENTION

The present invention is directed to systems and methods for monitoringthe performance of a caregiver. Simultaneously, the present invention isdirected to systems and methods for monitoring the movement of eachsubject in a network of subjects and the response of the caregiver.

One system is shown to include a plurality of sensors, preferably in theform of strips disposed in spaced-apart relation to a mattress pad. Thestrips extend longitudinally from the head end of the mattress pad. Themattress pad is configured to be placed on top of a mattress, and tothen be covered by a standard nylon slip-cover or the like that fitsover the mattress and the mattress pad.

All software aspects of the invention have been written to be portableto multiple operating systems and hardware platforms. Open sourceapplications and development tools have been used to limit downstreamsystem, licensing and development costs. Web browser based data entryand reporting systems have been used to reduce client costs and allowusers to interact with the system on familiar interfaces and hardware.It also allows handheld devices, pagers, cell phones, tablet PCs, etc.to be used without additional software development costs. Raw data isalways stored so future enhanced data analysis tools have access to theoriginal data. Multiple levels of security are used to protect theintegrity and confidentiality of the data.

This system may include hardware and functionality in order to functionas a bedside based undergarment moisture detector. In such a case,transmission of moisture data from patient undergarment to bedside wouldbe performed via Wireless link such as RFID, ZigBee™, IR, Bluetooth™,etc. A small probe, such as a very thin wire is penetrated through theouter plastic surface into absorbency material. The probe could bedesigned to penetrate the backside of undergarment and be positionedwhere it could detect moisture. A very thin wire could run from thesensor to a small transmitter which would be attached to the frontundergarment waistline of the subject. This front side transmitter couldbe a low cost, high efficiency, reusable transmitter which would enabledata to be transmitted area wide or to the bedside DCT. At apredetermined value, the CNA could be notified that the subject was inneed of an undergarment change. The major advantage that the CNA wouldno longer need to perform periodic checks, but only when specificallyneeded.

A nurse call module is provided and is adapted to be used as a deviceable to detect when a nurse call is placed on a conventional system andwhen it is answered. As the call is placed, the inline module detects anurse call signal and then independently sends this signal back to thebedside DCT which then transmits it to the central processor where it istime and date stamped, and then incorporated into the database relativeto the patient and/or DCT ID. In addition to the conventional audio andvisual signals generated during a nurse call, the system also pages,emails or notifies via mobile phone that a subject is in need ofassistance. Once the care has been rendered, the CNA would switch offthe bedside nurse call device which would also signal the spy device tostamp the database with a time and date. The proposed device would be anin-line component which would be “jacked” into the wall and then thenurse call connector would be snapped into this device. The spy devicecould communicate to the DCT or other type of bedside transmitter via ahard wire or wireless connection. The major advantage of the system ofthe present invention is that the existing nurse call system wouldperform as intended, with the added advantage of verifiable care giverperformance response time, thus allowing a better method of caregiverquality control.

A proposed system could also act as a bed alarm, monitoring when the bedis occupied or when it is empty, thus allowing the caregiver to benotified when a high risk “fall” subject is out of bed and in danger offalling while unattended. This warning system could be linked to theexisting in-house audio and visual indicators as well as nurse stationcomputer screen notification in addition to mobile phone, pager andother communication systems.

The DCT has an excess of bandwidth in both its wireless and hardwiredconfigurations. This additional capacity combined with its currentfunction as a bedside data collection and transmission device providestremendous opportunities for additional in-room capabilities. Some ofthese concepts include voice, data and video communication, including aroom call and patient audio and video monitoring. Other capabilitiesinclude high bandwidth devices such as sensors or monitors plus in-roominternet connectivity.

Additional features of the invention will become apparent to thoseskilled in the art upon consideration of the following detaileddescription of preferred embodiments exemplifying the best mode ofcarrying out the invention as presently perceived.

BRIEF DESCRIPTION OF THE DRAWINGS

A detailed description particularly refers to the accompanying figuresin which:

FIG. 1 is a schematic view of the monitoring system;

FIG. 2 is a cutaway perspective view of the head end of a mattress padwith sensors according to an embodiment of the invention;

FIG. 3 is a top plan view of the mattress pad and sensors;

FIG. 4 is an elevation view of the mattress pad;

FIG. 5 is a top plan view of a mattress pad and sensors covered by amattress cover according to another embodiment of the present invention;

FIG. 6 is an elevation view of the mattress pad of FIG. 5 and amattress, both of which are covered by a mattress cover;

FIG. 7 is a cutaway view of part of FIG. 5, showing the mattress,mattress pad, and fastener, all of which are covered by the mattresscover;

FIGS. 8-12 each show a subset of operational steps of a data collectortransmitter and the software therefor according to a method of operationof the present invention;

FIGS. 13-20 each show a subset of operational steps of the data serversoftware according to a method of operation of the present invention;

FIG. 21 shows a “Home Page” according to an embodiment of the presentinvention;

FIG. 22 shows a “24 Hour Facility Activity Report Page” according to anembodiment of the present invention;

FIG. 23 shows a “View Room Groups Page” according to an embodiment ofthe present invention;

FIG. 24 shows a “Patient Reports Page” according to an embodiment of thepresent invention;

FIG. 25 shows a “Monitor Reports Page” according to an embodiment of thepresent invention;

FIG. 26 shows a “Room Status Reports Page” according to an embodiment ofthe present invention;

FIG. 27 shows a “Patient Administration Entry Form Page” according to anembodiment of the present invention;

FIG. 28 shows a “New Bed Monitor Entry Form Page” according to anembodiment of the present invention;

FIG. 29 shows an “Edit Room Groups Form Page” according to an embodimentof the present invention; and

FIG. 30 shows an “Edit Room Administration Page” according to anembodiment of the present invention.

DETAILED DESCRIPTION OF EMBODIMENTS OF THE INVENTION

A system 31 for monitoring the performance of a caregiver relative tomovement of a single subject 32 or a plurality of subjects 32 is shownin FIG. 1. Illustratively, subject 32 is positioned on a bed 34, but itshould be understood that other subject support devices, such as chairs,wheelchairs, or the like, are within the scope of the invention.Accordingly, all of the attributes of the system described herein can beapplied to any type of subject support device.

As shown in FIG. 1, system 31 includes a plurality of beds 34, eachhaving a sensor 36 that is in communication with a central processor 38,such as that which can be found in the computer shown in FIG. 1. Thesensor 36 may be a single sensor or preferably a sensor array includinga plurality of individual or separate sensor units. The centralprocessor 38 may take the form of other computing devices having thecapability of detecting changes in the status of sensors 36 andoutputting an alarm, notice or report, for example. The system 31preferably uses a web browser based reporting system. Reports aregenerated on a web server (not shown) and viewed on standard webbrowsers with no special software required. The data is presented in ahierarchical fashion giving a quick overview as well as the ability todrill down to the lowest level of interest. The reporting system isdesigned to quickly identify areas of the facility that may needattention. Other functions of the central processor 38 will be explainedin more detail below.

The sensors 36 may include electrically conductive strips, which whenthey are brought into proximity or are permitted to disconnect, undergoa change of state with respect to, for example, opening or closing acircuit.

Other sensors are also contemplated that are capable of sensing a changeof position or status of a subject, such as pressure sensors, heatsensors, and so on. The sensors 36 may include conductive material, suchas conductive paint, plastic, metal or any other material that whentriggered functions to register or detect a change of status of asubject operatively associated with the sensor and generate or permitthe generation of a signal or event therefor.

Sensors 36 may communicate with processor 38 via a wireless (WiFi)connection, using wireless transmitters 40 that communicate with a basestation 42 that is connected with processor 38. The transmitters, bothshown at 40 and 46, and based on a Motorola IC, part no. 33794, are alsoknown as a data collector transmitter (DCT), which is a slave devicethat transmits data to a master device 38 using a predefined protocol.The protocol is designed to be compatible with a wide range of networksincluding, but not limited to RS232, multi-drop RS485 as well as higherlevel networks such as Ethernet, Bluetooth™, ZigBee™, 802.15.4 and WiFi.Addressing and error detection is provided at the lowest level of theprotocol for use on simple RS485 type networks.

The data gathering master device 38 is used to collect data from theslave DCT units 40, 46. The device 38 requests data from each DCT 40, 46at the desired data rate. Preferably, the data gathering master device38 is a networked PC running applications designed to communicate withas many as several hundred DTC units 40, 46 at the same time. It is amulti-threaded, object oriented, fault tolerant program that can recoverfrom network and DCT 40, 46 problems in real time without affecting datagathering on the rest of the system 31. The device 38 may store all datainto a standard SQL relational database 39.

The master device 38 may be a standard PC running a Java application.The program reads and writes to a database 39. The device 38 usesconventional programming to interface with the database 39, soportability to other databases is possible. The device 38 polls thedatabase 39 at regular intervals to determine the number of clients (DCTunits or installations) it needs to communicate with. Each DCT device40, 46 has a unique address and communication rate stored in thedatabase 39. The device and the applications running thereon aremulti-threaded so problems with individual devices and network latencydo not affect other devices and program performance. If one slave device40, 46 is not responding, all other devices will still return data atthe predetermined rate. The device 38 will continue to try to regaincommunication with the non-responsive slave until it is successful orthe entry in the database is removed. The data received from the slavedevices 40, 46 is stored in the database 39. The data is time stampedand referenced to the slave device 40, 46. To reduce the databasegrowth, if there is no movement by the subject, or if the subject is nolonger in bed, the recorded sensor values will be at wider intervals.However, once movement is again detected, the system will be triggeredto begin collecting data at a more rapid and predetermined pace allowingfull resolution of the subject movement. Even if the minimum changeamount has not occurred, data will at least be stored at a predeterminedinterval such as once every 10 seconds, for example, or at any suitableinterval. The master device 38 is intended to run autonomously.

The sensor pad 36 is connected to the DCT 46, which includes amicrocontroller. The microcontroller has custom software written in theC programming language. The microcontroller constantly polls the sensorlooping between the 9 electrodes of the sensor 36 using one of severalbuilt in 10-bit analog to digital channels. The microcontroller cancalibrate the system to adjust the output of the electrodes so they allread roughly the same value when no subject 32 is in the bed 34. It canalso adjust the high and low end points of the sensor values to use thefull 10-bit range. The calibration values are stored in non-volatileEEPROM so they are not lost if the power is interrupted or removed. Theread values are adjusted by the stored calibration and stored in RAM.The values in RAM are then used to quickly respond to the master devicewhen requested.

All communication is done with the microcontroller using a serial dataprotocol. The protocol uses an 8-bit address and a 16-bit CRC to insuredata integrity. While the address and CRC are not needed withhigher-level networks like Ethernet, they allow the use of future,simpler networks like RS485. The DCT 40, 46 currently uses an OEM serialto Ethernet device (not shown), but another embodiment includesintegration into the microcontroller.

Although wireless transmitters 40 are shown in FIG. 1 to be separatefrom sensors 36, and connected with a wire 44, it is within the scope ofthe invention to combine the wireless transmitter 40 with the sensor orto place it in other locations, such as within a bed mattress. Wirelesstransmitters 40 are illustratively capable of collecting data from itsassociated sensor 36. The system 31 is preferably configured so as to becapable of handling upwards of a hundred beds or more that may comprisea hospital network or a nursing home network, for example.

As an alternative, a transmitter 46 may be used, the transmitter 46having a wired (e.g., Ethernet) connection with processor 38.Illustratively, transmitter 46 uses an Ethernet network consisting ofEthernet cables 48 and an Ethernet hub 50 that is in communication withprocessor 38. Of course, system 31 may include both wireless andEthernet elements, and may be connected via other means and/orprotocols, such as coaxial cable, electrical wires, radio frequency,Bluetooth™, ZigBee™, 802.15.4 or any other manner for communicating datathat is known in the art.

As can be seen in FIGS. 2-7, sensor 36 comprises a mattress pad 54having an array of parallel conductive fabric strips 58 adhered thereto.Strips 58 extend longitudinally along the mattress pad 54, starting atthe head end 60. A fastener 52 may be coupled to one end of each of thestrips 58 at the head end 60 of the mattress pad 54. While theillustrated embodiment contemplates the adhesion of the strips 58 to anupper surface 64 of the mattress pad 54, it should be understood thatother configurations and fastening methods are within the scope of theinvention, including the placement of the strips 58 within the pad 54,or on top of another surface such as directly on top of a mattress 56.

In the illustrated embodiment, strips 58 are evenly spaced at aninterval A (shown in FIG. 3), such as four inches. Strips 58 areillustratively width B, which is approximately one inch in the presentlyshown embodiment.

Mattress pad 54 is illustratively a half-inch thick urethane foam padthat is cut to the same dimensions as a mattress 56 on which it is to bepositioned. Such urethane foam is flame retardant, thereby meeting theFF 4-72 (cigarette test) standards for flammability set forth by theConsumer Product Safety Commission. Furthermore, the foam preferablyconforms to the California Technical Information Bulletin No. 117regarding combustibility.

In the illustrated embodiment, nine strips 58 are positioned in parallelorientation to run longitudinally from the head end 60 of mattress pad54. Each of the strips has an adhesive bottom surface (not shown) thatis configured to adhere to the mattress pad 54. The adhesive surface isillustratively a pressure sensitive adhesive (PSA), however, otheradhesives are within the scope of this invention. After each of thestrips 58 is adhered to a top side 64 of the mattress pad 54, the entiremattress pad is overlaid with a flame retardant polyester cloth 55,(FIG. 7) thereby capturing the strips 58 and functioning so that thestrips remain securely in place throughout the life of the mattress pad.

Strips 58 may be any suitable thickness, such as approximately 0.008inches thick and made of a conductive laminated fabric. The laminatedfabric is flame retardant with a UL 94 V-0 rating. One example of such afabric is manufactured by Laird Technologies of St. Louis, Mo.

As can best be seen in FIGS. 5-7, which shows another embodiment of aportion of the present invention, an outer mattress cover 62 ispositioned over mattress 56 and overlying mattress pad 54 so that theentire sensor 36 is removed from direct contact with sheets or asubject. Mattress cover 62 is preferably a standard nylon covering usedover a standard nursing home mattress.

As can be seen in FIGS. 2, 3, and 7, a fastener 52 is pressed into eachof the strips 58, providing an electrical connection therewith. Fastener52 may be a male metallic snap fastener that functions as the connectionpoint between the conductive fabric and a connector harness 44.

The connector harness 44 links the array of strips 58 to either awireless transmitter 40 or a standard, wired transmitter 46 (FIG. 1). Asmentioned above, the transmitter 40, 46 functions as a data collectorand a transmitter of such data. In one embodiment, the harness 44 mayinclude nine coaxial conductors approximately 30 inches in length. Eachof the individual coaxial conductors is approximately ⅛ inch indiameter. At the end proximal to the mattress pad 34, each of thecoaxial connectors is terminated by a ⅛ inch crimp-on ring terminal,which allows simple and secure attachment to the array of stripsutilizing the female snap ring to capture the ring connector (notshown).

The end (not shown) of the harness 44 which attaches to the transmitter40, 46 may include a D-Sub 15-pin male connector. Each of the ninecoaxial center leads (not shown) may be individually crimped into aconnector pin and inserted into locations within the connector backshell. Each of the nine outer shields from each coaxial conductor may besoldered with a “drain wire” or alternately, stripped and combined intoa single termination which may be soldered together to ensure propertermination, and covered with a heat-shrink insulator. All nine drainwires may then be combined into a single conductor and crimped into theconductor as a tenth pin connector. Through the use of coaxialconductors, signal integrity to and from the array of strips 58 tend tobe consistent and reliable during operation.

The back shell (not shown) also permits the ability to monitor andverify whether the connector is securely attached to the transmitter 40,46. A wire loop (not shown) can be configured to connect to two specificpins within the back shell. Alternately, a single wire may be used withthe actual metallic back shell, used as the other conductor, and actingas a complete circuit when connected. When the wire completes the simplecircuit within the transmitter 40, 46, the electronic circuitry willindicate that all systems are functional. Should the connector unfastenfrom the back of the transmitter 40, 46 the circuit will be broken,which will immediately flag the system 31, advising that the connectionbetween the array of strips 58 and the transmitter 40 (or 46) has beenbroken.

The transmitters 40, 46 utilize E-field sensing technology combined witha programmable microcontroller that acts as the computing portion ofsystem 31. The transmitter 40, 46 performs multiple functions bycommunicating with the array of sensors 36 and then transmitting thisinformation to a remote database 39 (FIG. 1) for interpretation andreview. The database 39 stores data for the facility, room groupings(wings, floor, building, etc.), rooms, and subjects 32. The database 39also stores addressing and configuration information for the DCT units40, 46. Finally, the database 39 also stores all of the loggedinformation from the DCT units 40, 46.

The database 39 also stores other data related to the installationfacility. This allows data to be correlated to the facility, facilityzones, caregivers and subjects. The facility information is entered intothe system 31 using a web browser. The interface is designed to allowvery efficient data entry.

Each DCT 40, 46 generate a unique e-field to each of the nine strips 58within the array of strips. As each of these strips 58 are energizedwith a very low e-field, within milliseconds, a unique signal isreturned relative to the size and position of the subject 32 above thestrip 38. In the present embodiment, this is performed continuouslyacross all nine strips 58, taking full positional information twiceevery second. Any change in the position of the subject 32 generates achange in the electrical field of the array of strips 38. Other schemesare also contemplated, such that sufficient information is collected todetect movement of the subject 32.

Once a transmitter 40, 46 has received the information from the array ofstrips 58, the information is converted into a digital code and sent vianetwork to an onsite computer 38 (FIG. 1) for inclusion into a database39 (FIG. 1) correlated to specific bed information, along with a timeand date stamp. The transmitter 40, 46 is designed to be flexible in itsdata transmission mode and can be utilized in a hard wired or wirelessnetwork mode, as disclosed above.

Each transmitter 40, 46 can be powered by a 12-volt wall-mounted powersupply capable of a maximum 500 milliamp current draw. Alternately, itis envisioned that an internal power source could be utilized in lieu ofan external power source. Examples include lead acid, NiMH, and fuelcell type power sources. The transmitter 40, 46 also incorporates asolid state, resettable fuse insuring that the current will be cut offshould there be any reason that current is drawn above the requiredpower draw for the device. The housing for the transmitter may be formedby injection molding with ABS plastic having a flame retardant rating ofUL94 V0.

Ethernet hub 50 can be a standard 10/100 hub that can be found at anycomputer or electronic store. Base station 42 can also be a standardwireless/hard-wired base station that can communicate, for example, overthe 802.11 standard for wireless communications. It should beunderstood, however, that other configurations are within the scope ofthe invention, for example, base station 42 and Ethernet hub 50 could becombined into one device. System 31 can be configured to notify selectedpersons, i.e. nursing home or hospital management, via pagers 53, cellphones 51, e-mail 49, (see FIG. 1), fax, etc. through an Internetconnection 47, wired or wireless or any suitable communication means ormethod.

System 31 can also be connected to the Internet 47 (FIG. 1) to permitremote access via either an in-house web page or a secure connectionutilizing a standard web browser. The client interface may be entirelyweb browser based. The web pages may be served from a Windows InternetInformation Server (IIS) using the PHP scripting language. The clientscan see the data as pure standards based HTML without any specialapplications or plug-ins required. This allows any browser and operatingsystem to access the system. Varying levels of access can be granted foraccess to the data stored by the system 31.

A software program manages the microcontroller, providing control of theE-field. It also routes the data out of the transmitter 40, 46 and intothe network.

The processor 38 functions in at least two capacities: data gatheringand incorporation into a database 39 (FIG. 1) stored in or incommunication with processor 38, and data interpretation and reportgeneration. The database 39 can track the data from each of thetransmitters 40, 46 on a continuous basis. In the present embodiment,information from each strip 38 in the array of strips is stored and timestamped twice every second. The database 39 then stores the informationand can group the information, for example, to track: (a) unique bed,floor/wing, and facility information relative to a caregiversresponsibility (b) individual subject position data as a function oftime (c) transmitter information relating to IT addresses and otherhardware characteristics and (d) facility names and other identifiablecharacteristics.

The database 39 stores data from each transmitter 40, 46, which can betime-stamped for analysis and interpretation. Through the use of dataanalysis processes executed by software (detailed below) meaningfulindicators can be established to confirm caregiver activity and theassociated subject movement relative to specified medical orders. Theoutput data may be selectable so as to provide a morning report giving abrief overview of caregiver performance on targeted subject rotations.Additionally, weekly and monthly performance reports may be created andcan again be arranged by a particular caregiver.

In operation, the system 31 may be used as follows. A facility managermay review a status report displayed on or printed through processor 38upon his/her arrival at the beginning of the shift. Such a status reportcould show the performance of caregivers on the prior shift, as well asany movement of the subject 32. The report could correlate movement orcaregiver-initiated movement with that ordered by a physician. Otherreports may be executed that show movement over a longer period of time,or even that show performance of a particular caregiver over a period oftime. Results could also be color coded, could be arranged by buildingwings or groups of rooms, or arranged in any other manner that isintuitive or preferred to the management. Information could be passwordprotected in order to prevent the breach of security.

It is an advantage of the system 31 that no direct subject contact needoccur and the system is nearly completely out of sight from the subject32. In the event that the system 31 is disabled or switched off, noadverse side effects will occur since the system is not attached to thesubject. Furthermore, the immediate health of the subject is notdependent upon the operation of the system 31.

FIG. 8 shows the initialization sequence of the data collectortransmitter (DCT). The DCT is powered on 102. The hardware portion ofthe DCT is initialized 104 and an indicator, such as an LED is used toindicate start-up, preferably by blinking on and off or by displaying apredetermined first color 106. Interrupts and timers are enabled 108.Configuration and calibration data is read 110, preferably off of anon-volatile device, such as non-volatile EEPROM. Variables areinitialized and the first sensor is selected 112. The program thenenters an infinite loop of reading the sensors in sequential order. Theprocess waits a predetermined amount of time while the sensor settles114. At step 116, the DCT begins to read the sensor. The microprocessorwill generate an interrupt when the analog to digital conversion iscomplete. Before the process loops back to step 114, it checks to see ifa completed calibration needs to be saved 118. When an analog to digitalconversion completes, an interrupt occurs (FIG. 12) and the value issaved to RAM 164. At this time, calibration calculation and/or digitalfiltering may occur, depending on the current mode of operation. Thecurrent sensor number is then indexed 166 to the next number or returnsto the first number if the highest numbered sensor was just read 168.

The serial data receive process is also interrupt based (FIG. 9). Aninterrupt is generated for each character received. A communicationtimer is restarted 124 after the receipt of each character to clear thebuffer if partial messages or erroneous data are received (FIG. 11).Each character is analyzed in sequence to determine when a full messageis received 130-146. A CRC (Cyclic Redundancy Check) is then calculated142 and checked for errors against the message for errors. If anythingis wrong with the message, the buffer is cleared 134 and the DCT waitsfor the next message. If the message is valid, the DCT responds withdata and actions are taken. Modes are set as required 144.

A general purpose timer (FIG. 10) also generates an interrupt on aperiodic basis. On each of these interrupts, the DCT does a generalstatus check to determine if any problems have occurred; such as sensorcable disconnection or other communications errors. The fault LED willtoggle state 152 at this time if a fault exists.

FIG. 12 shows the startup sequence of the data server. The graphicalinterface is initialized, and then a “collection” is created to trackthe active slave devices (DCTs). A timer is started that willperiodically check the database to determine if new DCTs need to beadded to the collection or if any need to be removed.

When the DCT check timer event occurs, (FIG. 14) the active DCT list isread from the database. The program loops through the records todetermine if any DCTs are new or need to be removed.

Each DCT is communicated with using its own program thread (FIG. 17).This prevents problems with other DCTs from affecting communication withother DCTs. At the creation of each thread, a log interval timer is setup 208. A network connection is then attempted to be established 210.This will loop forever until a connection is established or the threadis terminated. The main server thread is informed of the currentconnection status of each thread 214, 216. If a connection isestablished, the log interval timer is then started 218.

When a log timer event occurs 222, a message is sent to the DCTrequesting current sensor values. The thread will then wait until thedata received event occurs (FIG. 20). The message will be verified forintegrity 244. Valid data messages will generate an event 250 for themain server thread (FIG. 15).

When DCT data received events occur, (FIG. 15) the server stores thedata in the database, time stamped and tagged to the patient 200. WhenDCT threads detect a change in status of the DCT, it will generate astatus change event. When these events occur, the main server threadupdates the interface and writes to the database.

The system 31 user software is preferably designed to operate as a webbased system with the functionality of being easily accessed on-site orfrom a remote location using a standard web browser, e.g., MicrosoftInternet Explorer™ or an equivalent thereof. The browser enabledinterface (see FIG. 21) is designed to operate independently from allother software elements within the system 31, including the “bed logs”database 39 and data collection 36, 40 portions of the overall system.The “Home Page” 100, shown in FIG. 21, is also the main screen which allusers will first encounter when interfacing with the system 31.

The home page 100 is broken out into two main sections, a reportgenerating portion 102 and administrative portion 104 including patient,monitor and room information. All of these individual sections may bepassword protected depending on the pre-determined authorization of theend-user. At any time within the various sub-menus, the logo 106 may beclicked which will take the user back to the home page 100.

An objective of the system 31 is to insure that while a patient is underthe care of a healthcare professional; all rotations are performed atthe specified intervals as dictated by medical orders. The system 31will continuously provide critical caregiver performance data detailingthe type of movement performed and most importantly time and date ofthese interactions insuring that a formal record of performance isestablished.

The “24 Hour Facility Activity Report,” 110, FIG. 22, is intended to actas a quick facility scorecard, which will visually indicate overallperformance of all assigned caregivers, relative to all rotationsrequired throughout the entire facility duty shift. This record will betypically reviewed by a manager or supervisor at the end of a facilityshift. Although the report described is based on a 24 hour duty cycle,additional reports will include other durations including real-timeinformation, weekly or monthly performance indicators.

Three simple visual indicators 112 will show green, yellow or red, forexample, describing level of performance within the facility. If theindicator is green, this may confirm that all rotations within thefacility were performed according to specified medical orders. If theindicator is yellow, this may mean “caution” which points to the factthat specific patients may not have been rotated as required by medicalorders and/or at the specified times. Additional investigation may berequired to determine what had transpired during the interval underquestion. The red indicator may specify that there may have beensignificant portions of the patient rotation regimen not completed. Nearthe bottom of the page 114, the end user can click on the “View RoomGroups” to drill down further into caregiver performance data relativeto individual caregivers on specific floors or facility wings.

The View Room Groups screen 120 (FIG. 23) is designed to show roomgroupings within a facility, which are typically tied to a specificcaregiver during their duty shift. This information will allow facilitymanagement to determine which specific rooms, beds and the specificpatients that were not rotated during a set period of time.

The Patient, Monitor and Room Status Reports, 130, 140, and 150 (seeFIGS. 24-26) are displays which provide the accurate and up to dateinformation for the system 31. Patient Status Report 130 provides thelocation of the patient by both room and overall grouping. This insuresthat the information to be also tied back to the specific caregivers'responsible for these specific room groupings. The Monitor Status Report140 advises which monitors are available for use within the facility andalso which units are currently in service at the patient bedside.Additional information includes serial number, patient name that is tiedto the DCT and IP address. Other information includes data collectionintervals for each patient. The Room Status Report 150 details patientname, Data Collector Transmitter (DCT) serial number, room number andoverall room grouping.

The Patient Administration Entry Form 160 (see FIG. 27) provides asimple and effective method to enter patient data into the systemrecords 39. Additional information required includes Room Group, RoomNumber, turn frequency (default 120 minutes) and allowable turn window(e.g., 15 minutes). Ideally a patient should be rotated precisely at theprescribed turn frequency, for example every two hours, however, due toactual workload and other demands on caregiver time; they may not beable to rotate a patient at an exact time interval. The allowable turnwindow will provide an additional time range which allows the caregiverto perform a specified or required rotation within a pre-set timeinterval, for example 15 minutes beyond the two hour turn frequency.Should a patient remain unturned beyond the established turn windowinterval, the system will “flag” this record providing the manager withan indicator that the caregiver has missed a turn. The entry form alsoallows editing of the patient information in the event the patientchanges rooms or leaves the facility.

The New Bed Monitor Entry Form 170 (see FIG. 28) is intended to allowfacility managers to add new monitor devices to the facility. It alsoallows several selectable functions regarding data transmission viaeither hardwired or wireless link. Other features include assignablequery rate, maximum log intervals, patient info and activation check box(turn on or turn off communication with DCT). This entry form alsoallows editing of existing monitor information.

The Edit Room Groups Form 180 (see FIG. 29) allows easy addition,modification or deletion of specific room groupings. Typically theseroom groups will be tied directly to specific caregiver room assignmentswithin a facility, thus tying the assigned caregiver to their groupingof rooms. Once the room groups are set, only patient rooms fallingwithin these groups will be in the dropdown menu. For example if thereis a “South Room Group” only specific rooms that are pre-assigned duringsetup will be within the dropdown menu. Other rooms within the facilitywill be tied to their proper, pre-determined room group. In addition, afull report may be viewed detailing all room groups within a facility

The Edit Room Administration Form 190 (see FIG. 30) will allow afacility manager to add, modify or delete rooms within a specific roomgroup. There is also a feature to view the specific rooms and how theyrelate to specific room groups.

Other features such as data export, import, analysis and graphicvisualizations may be considered important in the expansion andenhancement of the system 31.

While the disclosure is susceptible to various modifications andalternative forms, specific exemplary embodiments thereof have beenshown by way of example in the drawings and have herein been describedin detail. It should be understood, however, that there is no intent tolimit the disclosure to the particular forms disclosed, but on thecontrary, the intention is to cover all modifications, equivalents, andalternatives falling within the spirit and scope of the disclosure asdefined by the appended claims.

There is a plurality of advantages of the present invention arising fromthe various features of the subject monitoring system and associatedmethod described herein. It will be noted that alternative embodimentsof the subject monitoring system and associated method of the presentinvention may not include all of the features described yet stillbenefit from at least some of the advantages of such features. Those ofordinary skill in the art may readily devise their own implementationsof a subject monitoring system and associated method that incorporateone or more of the features of the present invention and fall within thespirit and scope of the present invention as defined by the appendedclaims.

1. A system for monitoring performance of a caregiver, the systemcomprising: a mattress pad; a sensor attached to said mattress pad, eachsaid sensor capable of sensing movement of a subject and capable ofgenerating a signal corresponding to movement of the subject; aprocessor in communication with said sensor, said processor beingprovided with computer readable code for generating a report related tothe performance of the caregiver.
 2. The system of claim 1, furthercomprising a plurality of said mattress pads, each said mattress padhaving one or more of said sensor attached thereto.
 3. The system ofclaim 1, wherein said sensor includes a plurality of fabric stripsmanufactured from a conductive material.
 4. The system of claim 1,wherein said sensor includes a plurality of sensors longitudinallyadhered to said mattress pad in spaced apart intervals.
 5. The system ofclaim 1, wherein said sensor is capable of detecting a change oforientation or position of the subject.
 6. The system of claim 1,wherein said mattress pad is a urethane foam pad.
 7. The system of claim4, further comprising a plurality of electrically conductive fasteners,each fastener engaging a respective one of said plurality of sensors. 8.The system of claim 1, further comprising a transmitter for transmittingsignals generated by said sensor and conveying said signals to saidprocessor.
 9. The system of claim 8, wherein said transmitter iswireless.
 10. The system of claim 8, wherein said transmitter is furtherconfigured to collect signal data prior to transmitting said signaldata.
 11. A system for monitoring the performance of a caregiver, thesystem comprising: a plurality of mattress pads; a plurality of stripsconfigured to adhere to each of said plurality of mattress pads, each ofsaid plurality of strips having an electrical field sensitivity andcapable of creating signals based on the electrical field sensed; aplurality of transmitters, each of said plurality of transmitters beingcoupled with said plurality of strips adhered to one of said pluralityof mattress pads; and a processor in communication with said pluralityof transmitters; said processor being provided with computer readablecode for generating a report related to the performance of thecaregiver.
 12. The system of claim 11, wherein each of said stripscomprises a conductive fabric material.
 13. The system of claim 11,wherein each of said strips is longitudinally adhered to said mattresspad in spaced apart intervals.
 14. The system of claim 11, wherein eachof said strips extends from a head end of said mattress pad toward alongitudinally central portion of said mattress pad.
 15. The system ofclaim 11, wherein each of said strips is capable of detecting a changeof orientation or position.
 16. The system of claim 11, wherein saidprocessor receives signals from said transmitters at a frequency of atleast two signals per second.
 17. The system of claim 11, wherein saidprocessor is configured to provide a customized report relating tomovement sensed by said plurality of strips.
 18. A method of monitoringthe performance of a caregiver, comprising the steps of: providingspaced-apart electronic sensors along a portion of a subject supportdevice; periodically querying said sensors for data related to theposition of the subject; transmitting the data to a processor;processing the data to determine whether significant subject movementhas occurred; and outputting the data in a user-selected manner relatedto performance of the caregiver.
 19. The method of claim 18, wherein thesensors are flexible fabric strips.
 20. The method of claim 18, whereinthe electronic sensors are positioned in a mattress pad.
 21. The methodof claim 20, wherein the electron sensors are adhesively secured to themattress pad.
 22. The method of claim 18, wherein the electron sensorsare queried approximately twice per second.
 23. The method of claim 18,wherein said transmitting step occurs through at least one protocolselected from the group comprising LAN-based data transmission, wirelessdata transmission, infrared transmission, Bluetooth™ transmission, andRF transmission.
 24. The method of claim 18, wherein said processingstep includes time and date stamping of the data.
 25. The method ofclaim 18, wherein said processing step includes formatting the data foroutput on a caregiver-by-caregiver basis.